Healthcare Provider Details

I. General information

NPI: 1306216478
Provider Name (Legal Business Name): SHANE SAENZ PSYD, CMPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 5TH ST
DAVIS CA
95616
US

IV. Provider business mailing address

2020 5TH ST PO BOX #12
DAVIS CA
95616
US

V. Phone/Fax

Practice location:
  • Phone: 530-214-0824
  • Fax:
Mailing address:
  • Phone: 530-214-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: